A report issued by the American Civil Liberties Union claims that an increase in the number of Catholic hospitals in the United States is limiting women's reproductive health care because those facilities must follow religious and ethical guidelines, including the church's prohibition on abortion.

The 38-page report -- "Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care" -- was issued by the ACLU and MergerWatch, a New York-based nonprofit group that tracks hospital consolidations.

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The report, made public Dec. 18, says that 10 of the top 25 health systems in the U.S. are Catholic and about one in nine acute-care beds in 2011 was in a Catholic-sponsored or affiliated hospital.

There was no direct response to the report's claims from the Catholic Health Association, which is the national leadership organization of more than 1,200 Catholic health care sponsors, systems, facilities, and related organizations and services.

However, Jeff Tieman, CHA's chief of staff in its Washington office, referred Catholic News Service to a statement CHA released Dec. 9 in response to a similar claim made in a Dec. 8 New York Times editorial, which the CHA called "misleading and in error."

Like the report, the editorial claimed mergers between secular hospitals and Catholic hospitals and the U.S. bishops' ethical and religious directives that guide Catholic health care restrict quality reproductive care for women and medical care for their children.

The CHA said, "Catholic hospitals in the United States have a stellar history of caring for mothers and infants. Hundreds of thousands of patients have received extraordinary care -- both in the joy of welcoming an infant or in the pain of losing one. In many communities in our country, the Catholic hospital's maternity service is the designated center for high-risk pregnancies."

The Times editorial was published in response to a lawsuit filed Nov. 29 in U.S. District Court for the Eastern District of Michigan/Southern Division by ACLU's national office and its Michigan affiliate on behalf of Tamesha Means of Muskegon, Mich. The suit says because of the church's ethical and religious directives, she received negligent care at a Michigan Catholic hospital when her pregnancy was in crisis at 18 weeks, leading to the loss of her baby.

The suit -- also cited in the December ACLU report -- claims the directives kept the doctors from giving Means complete information about her condition, treatment options and adequate care, a situation that led her, it says, to suffer emotional and painful trauma that resulted in a premature birth, and the death of the baby shortly thereafter.

It names as defendants the U.S. Conference of Catholic Bishops; Mercy Health Muskegon, as it is now called, which is the hospital where Means sought care; and three former or current chairs of the board of the health care network that includes the hospital.

The USCCB "Ethical and Religious Directives for Catholic Health Care" address a wide range of ethical questions, such as abortion, euthanasia, care for the poor, medical research, treatment of rape victims and other issues. They are now in their fifth edition, approved by the U.S. bishops in 2009.

The ACLU report said the hospitals following these directives "prohibit a range of reproductive health services, including contraception, sterilization, many infertility treatments, and abortion, even when a woman's health or life is threatened by a pregnancy."

"In other words," the report said, "these Catholic health systems are increasingly big business, with great power in local, regional and national markets. They are also increasingly poised to influence health care policy."

In its lawsuit, the ACLU cites only one directive, No. 45, which says in part: "Abortion [that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus] is never permitted."

But there 72 directives, and in a recent interview with CNS, John Haas, president of the National Catholic Bioethics Center in Philadelphia, pointed out that a number of other directives were more applicable in the Means case, such as No. 27, which requires any hospital to get informed consent from a patient.

Directive No. 47 states: "Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child."

Beyond the directives, the CHA said in its Dec. 9 statement, several independent organizations have oversight responsibility for all hospitals, including Catholic hospitals.

"Nationally, for most hospitals it is the Joint Commission (JCAHO) and, in each state, there is a licensing agency. Both organizations have robust standards and inspections," it said. "They would not accredit or license a hospital that is unsafe for mothers or infants under any circumstance. Add to that the commitment of health professionals caring for these mothers."

The ACLU report calls for more government oversight of hospital mergers, affiliations, and acquisitions to "identify and address any potential loss of reproductive health care and other vital health services." It also urged state health departments to enforce rules requiring hospitals to post and report their policies on reproductive health care services they provide.

In a Dec. 6 statement about the lawsuit, Archbishop Joseph E. Kurtz of Louisville, Ky., USCCB president, said it was "baseless" for the ACLU to claim the directives encourage or require "substandard treatment of pregnant women" because they "do not approve the direct killing of their unborn children."

They "urge respectful and compassionate care for both mothers and their children, both during and after pregnancy," Archbishop Kurtz said.

They "restate the universal and consistent teaching of the Catholic Church on defending the life of the unborn child," he added, a teaching he noted "also mirrors the Hippocratic oath that gave rise to the very idea of medicine as a profession, a calling with its own life-affirming moral code."

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